Primary surgical options for acute corneal hydrops: A review

2021 ◽  
pp. 112067212110378
Author(s):  
Gonzalo García de Oteyza ◽  
Guido Bregliano ◽  
Irene Sassot ◽  
Luis Quintana ◽  
Carolina Rius ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Medical Therapy ◽  
Penetrating Keratoplasty ◽  
Corneal Transplantation ◽  
Corneal Edema ◽  
Self Healing ◽  
Surgical Options ◽  
Corneal Hydrops

Acute corneal hydrops usually resolves alone or with medical therapy along the first 4–6 weeks. However, depending on the severity of the corneal edema or the size of the Descemet break, self-healing might be difficult. Years ago, those patients had no more options than corneal transplantation, but surgical alternatives are on the rise in this century. These surgeries are becoming more popular with a variety of techniques relegating penetrating keratoplasty to a residual role. These techniques aim to accelerate corneal healing, reduce the edema, improve visual acuity and prevent from severe complications that may appear if corneal hydrops is not treated rapidly. Feasibility and safety are the favorable aspects of these techniques since the complications rates described remain low. In this review, we emphasize the recently published studies that describe both the techniques and their results.

scholarly journals DMEK IN KERATOCONUS WITH ACUTE HYDROPS: A CASE REPORT

2018 ◽  
Vol 17 (3) ◽  
pp. 81
Author(s):  
Lucio V L Maranhão ◽  
Paulo E C Dantas ◽  
Natalia R L Ramalho ◽  
Wanessa P Pinto
Keyword(s):  
Visual Acuity ◽  
Corneal Edema ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Hand Motion ◽  
Severe Visual Loss ◽  
Corrected Visual Acuity ◽  
Corneal Hydrops ◽  
The Right ◽  
Initial Results ◽  
Best Corrected Visual Acuity

We describe the initial results of a Descemet Membrane Endothelial Keratoplasty (DMEK) procedure for acute corneal hydrops in a 45-years female with keratoconus that presented with severe visual loss in the left eye (OS). The patients’ best-corrected visual acuity at presentation in the right eye was 20/80 and hand motion in OS. Slit-lamp examination revealed an extensive Descemet’s membrane tear and stromal corneal edema in OS. Two months after the DMEK procedure, the patient presented with a best corrected visual acuity of 20/200 in the affected eye, corneal edema improvement, and an attached Descemet graft.  

scholarly journals Corneal Imaging and Densitometry Measurements in Patients with Fuchs' Dystrophy Undergoing Penetrating Keratoplasty and Descemet's Striping Automated Endothelial Keratoplasty

2021 ◽  
Author(s):  
Khaled Alzahrani ◽  
Arun Brahma ◽  
Fiona Carley ◽  
M. Chantal Hillarby
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Corneal Thickness ◽  
Corneal Transplantation ◽  
Objective Evaluation ◽  
Endothelial Keratoplasty ◽  
Evaluation Tool ◽  
Corneal Densitometry ◽  
Post Surgery ◽  
Fuchs Dystrophy

Abstract Aims:In the present study, we used the densitometry software from the Oculus Pentacam to compare postoperative corneal clarity between penetrating keratoplasty (PK) and Descemet's stripping endothelial keratoplasty (DSAEK) in patients with Fuchs' dystrophy.Methods:A retrospective comparative study was carried out at Manchester Royal Eye Hospital. In 28 patients with Fuchs' dystrophy, corneal densitometry measurements were performed 12–18 months after corneal transplantation. The correlations of the densitometry measurements with the best corrected visual acuity (BCVA) and central corneal thickness (CCT) were analysed and compared between eyes that underwent PK and those that underwent DSAEKResults:Corneal densitometry measurements in the 33 eyes showed no significant differences between the PK and DSAEK post-surgery groups. There was no significant correlation between CCT and corneal densitometry measurements in either group (P > 0.05 in both cases). After DSAEK, corneal densitometry measurements were significantly correlated with BCVA in the central (P = 0.01), posterior (P = 0.007), and full-depth (P = 0.008) 0–2 mm zones of the cornea but not in PK group. The postoperative CCT was significantly different between the two groups (P˂0.01).Conclusion:The two types of corneal transplantation resulted in different outcomes in terms of corneal densitometry measurements. Improved visual acuity after DSAEK was found to positively correlate with improvements in corneal clarity. Oculus Pentacam provides an objective evaluation tool to monitor corneal status after surgery.

Using intracameral vital dye as a guide for venting incision in acute corneal hydrops

2018 ◽  
Vol 29 (6) ◽  
pp. 694-697
Author(s):  
Mohammad Soleimani ◽  
Reza Mirshahi ◽  
Seyed Ali Tabatabaei ◽  
Bita Momenaei ◽  
Mirataollah Salabati ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Surgical Technique ◽  
Anterior Chamber ◽  
Trypan Blue ◽  
Corneal Edema ◽  
Primary Site ◽  
Full Thickness ◽  
Corrected Visual Acuity ◽  
Corneal Hydrops ◽  
New Surgical Technique

Purpose: To introduce a new surgical technique for the localization of corneal bulla to drain a massive corneal hydrops. Methods: Four consecutive cases with acute large protruded hydrops were selected. A limbal paracentesis was made via 15° blade. Afterward, trypan blue with a concentration of 0.1% was injected into the anterior chamber. Upon pooling trypan blue in the bulla, the surgeon immediately marked the primary site of stromal staining before further spreading of the dye. Anterior chamber irrigation was then carried out using balanced salt solution, and the excess of trypan blue was washed out. Subsequently, the surgeon made a beveled venting incision to decompress bulla via 15° blade resulting in a stream of dye egressed from the venting incision. At the end of the surgery, 20% diluted SF6 was injected into the anterior chamber. Results: Postoperatively, Descemet’s membrane was attached up to the second postoperative day. The corneal edema was resolved up to 3 weeks. Contact lens–corrected visual acuity was improved in all cases. Conclusion: Venting incision under the guide of injected trypan blue into the anterior chamber combined with intracameral SF6 injection could be effectively used for a large acute hydrops. This technique could prevent other interventions like passing full-thickness corneal suturing and subsequent complications.

scholarly journals Penetrating Keratoplasty for Keratoconus – Excimer Versus Femtosecond Laser Trephination

2017 ◽  
Vol 11 (1) ◽  
pp. 225-240 ◽  
Author(s):  
Berthold Seitz ◽  
Achim Langenbucher ◽  
Tobias Hager ◽  
Edgar Janunts ◽  
Moatasem El-Husseiny ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Excimer Laser ◽  
Penetrating Keratoplasty ◽  
Contact Lenses ◽  
Corneal Transplantation ◽  
Correction Method ◽  
Good Prognosis ◽  
Severe Stage ◽  
First Choice

Background: In case of keratoconus, rigid gas-permeable contact lenses as the correction method of first choice allow for a good visual acuity for quite some time. In a severe stage of the disease with major cone-shaped protrusion of the cornea, even specially designed keratoconus contact lenses are no more tolerated. In case of existing contraindications for intrastromal ring segments, corneal transplantation typically has a very good prognosis. Methods: In case of advanced keratoconus – especially after corneal hydrops due to rupture of Descemet’s membrane – penetrating keratoplasty (PKP) still is the surgical method of first choice. Noncontact excimer laser trephination seems to be especially beneficial for eyes with iatrogenic keratectasia after LASIK and those with repeat grafts in case of “keratoconus recurrences” due to small grafts with thin host cornea. For donor trephination from the epithelial side, an artificial chamber is used. Wound closure is achieved with a double running cross-stitch suture according to Hoffmann. Graft size is adapted individually depending on corneal size („as large as possible – as small as necessary“). Limbal centration will be preferred intraoperatively due to optical displacement of the pupil. During the last 10 years femtosecond laser trephination has been introduced from the USA as a potentially advantageous approach. Results: Prospective clinical studies have shown that the technique of non-contact excimer laser PKP improves donor and recipient centration, reduces “vertical tilt” and “horizontal torsion” of the graft in the recipient bed, thus resulting in significantly less “all-sutures-out” keratometric astigmatism (2.8 vs. 5.7 D), higher regularity of the topography (SRI 0.80 vs. 0.98) and better visual acuity (0.80 vs. 0.63) in contrast to the motor trephine. The stage of the disease does not influence functional outcome after excimer laser PKP. Refractive outcomes of femtosecond laser keratoplasty, however, resemble that of the motor trephine. Conclusions: In contrast to the undisputed clinical advantages of excimer laser keratoplasty with orientation teeth/notches in keratoconus, the major disadvantage of femtosecond laser application is still the necessity of suction and applanation of the cone during trephination with intraoperative pitfalls and high postoperative astigmatism.

scholarly journals Inferior bullous keratopathy caused by iris fibers, resolved with diode laser 532

2018 ◽  
Vol 17 (3) ◽  
pp. 78-80
Author(s):  
Andres Fernando Polit ◽  
Fernando Eduardo Polit ◽  
Joaquin Polit
Keyword(s):  
Visual Acuity ◽  
Laser Diode ◽  
Corneal Transplantation ◽  
Corneal Edema ◽  
Bullous Keratopathy ◽  
Yag Laser ◽  
Corrected Visual Acuity ◽  
Body Sensation ◽  
Inferior Angle ◽  
Best Corrected Visual Acuity

Purpose: To describe a case of inferior bullous keratopathy caused by iris fibers resolved with laser diode 532.Case report: A 74-year-old woman consulted for deterioration of visual acuity in right eye, accompanied by foreign body sensation. A phacoemulsification surgery with IOL implant had been performed in both eyes three months before. Best corrected visual acuity reached 20/40 in right eye. Slit lamp examination revealed bullous keratopathy located in the central inferior quarter of the cornea of her right eye. Gonosioscopy was performed to rule out having nucleus fragments in the inferior angle. With higher magnification, a pair of fine undulating fibers were observed coming from the anterior layers of the iris and making contact with the posterior face of the cornea. Photocoagulation of the iris fibers was performed with laser diode 532 and photodisruption with Nd-YAG laser, applied at the base of the fibers. After nine days, resolution of corneal edema, and disappearance of bullae was observed.  Best corrected visual acuity improved to of 20/25.Conclusions: photocoagulation of iris fibers with laser diode 532 complemented with photodisruption with Nd-YAG laser, in patients with iridoschisis, is an alternative to avoid endothelial decompensation and corneal edema, which may require a corneal transplantation.

STUDY CLINICAL FEATURE AND RESULT OF TREATMENT PHACOMORPHIC GLAUCOMA

2015 ◽  
pp. 71-75
Author(s):  
Van Nam Phan ◽  
Ba Ken Tran
Keyword(s):  
Visual Acuity ◽  
Intraocular Pressure ◽  
Statistical Significance ◽  
Corneal Edema ◽  
Clinical Feature ◽  
Anterior Chamber Angle ◽  
Male Population ◽  
Significant Difference ◽  
Operative Complications ◽  
Before And After

Purpose: Study clinical feature of phacomorphic glaucoma. To evaluate the result of treatment phacomorphic glaucoma. Method: The retrospective, interventional study on 36 cases with phacomorphic glaucoma who underwent treated at Hue Central Hospital from 6/2010 to 6/2011. Standard of research: visual, IOP, before and after surgery, accompanying lesions and post-operative complications. The surgery is considered successful when postoperative IOP less than 21 mmHg. Results: Age 50-59 presented 30.5 percent, ≥ 60 presented 91.7 percent. There was a slight female preponderance (66.7%) compared to the male population (33.3%) which implies a statistically marginally significant difference. However there was no statistical significance difference when compared by the two subgroups. Patient in country presented 61,1% and city presented 38,9%. The duration between the onset of pain and surgery from 0 to < 5 days (77.8%), from 6 to 10 (16.7%) and >10 days presented 5.5%. The preoperative intraocular pressure 35 to 45mmHg (47.2%), 46-55 (30.6%), 56-65 (13.9%) and more than 65 presented 8.3%. The visual acuity preoperation less than 1metre count finger (94.5%), less than 3 metre count finger presented 5.5%. Close anterior chamber angle presented 80.6% and shallow was presented 19.4%. Corneal edema presented 100%, iritis presented 94.4%, dilated pupil larger 5mm presented 83.3%, Synchynea iris and cataract presented 72.2%. ECCE, implantation IOL combined trabeculectomy presented 11.1%, Phaco, implantation IOL combined trabeculectomy presented 69,5%, ECCE implantation IOL presented 5.6%, Phaco, implantation IOL presented 13.8%. Postoperative visual acuity from 1/10 to 5/10 presented 72.2%, no case have VA larger than 5/10. Postoperative 3 months VA 1/10 to 5/10 presented 72.2%, larger VA 5/10 presented 8.3%. Postoperative 3 months intraocular pressure ≤ 21mmHg presented 91.7%, 22 to 24mmHg presented 8.3%, no case have IOP ≥25mmHg. Postoperative edema presented 58.3%, iritis presented 58.3%. Key words: phacomorphic Glaucoma

scholarly journals Descemet membrane suturing to manage recurrent graft detachment in a patient with Descemet membrane endothelial keratoplasty on failed penetrating keratoplasty

2021 ◽  
Vol 13 ◽  
pp. 251584142110277
Author(s):  
Zahra Ashena ◽  
Thomas Hickman-Casey ◽  
Mayank A. Nanavaty
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Anterior Segment ◽  
Endothelial Keratoplasty ◽  
Descemet Membrane Endothelial Keratoplasty ◽  
Descemet Membrane ◽  
Ocular Coherence Tomography ◽  
Corrected Visual Acuity ◽  
Intracameral Injection ◽  
History Of

A 65-year-old patient with history of keratoconus, mild cataract and penetrating keratoplasty over 30 years ago developed corneal oedema subsequent of graft failure with best corrected visual acuity (BCVA) of counting fingers. He underwent a successful cataract surgery combined with a 7.25 mm Descemet’s Membrane Endothelial Keratoplasty (DMEK) with Sodium Hexafluoride (SF6) gas. His cornea remained oedematous inferiorly at 4 weeks, despite two subsequent re-bubbling due to persistent DMEK detachment inferiorly. This was managed by three radial full thickness 10-0 nylon sutures placed in the inferior cornea along with intracameral injection of air. Following this, his anterior segment ocular coherence tomography (OCT) confirmed complete attachment of the graft, and the sutures were removed 4 weeks later. Unaided visual acuity was 20/63 and BCVA was 20/32 after 8 months. DMEK suturing can be helpful in persistent DMEK detachments, which is refractory to repeated re-bubbling due to uneven posterior surface of previous PK.

Safety and Efficacy of Temporal Manual Small Incision Cataract Surgery in India

2011 ◽  
Vol 21 (6) ◽  
pp. 748-753 ◽  
Author(s):  
Swati V. Zawar ◽  
Parikshit Gogate
Keyword(s):  
Visual Acuity ◽  
Cataract Surgery ◽  
Corneal Edema ◽  
Posterior Chamber ◽  
Small Incision Cataract Surgery ◽  
Safety And Efficacy ◽  
Excellent Outcome ◽  
Sutureless Technique ◽  
Small Incision ◽  
Sandwich Method

Purpose. To assess safety and efficacy of temporal manual small incision cataract surgery (SICS) in context to visual outcome, astigmatism, and complications. Methods. This involved sclerocorneal tunnel, capsulotomy and hydrodissection. The incision was made with number 11 disposable surgical blade (costing Indian Rs. 2.50, $0.05). Nucleus extraction was done by phaco-sandwich method with the help of vectis and dialer. Posterior chamber intraocular lens implantation was done according to biometric findings. A record of intraoperative and postoperative complications was made. The final postoperative assessment of astigmatism was done with spectacle correction on the 45th day as per the refraction findings. Results. Two thousand eyes were operated by temporal, manual small incision sutureless technique. Uncorrected visual acuity was ≥6/18 in 1636 (81.7%) patients on the first postoperative day, in 1652 (82.6%) patients at 2 weeks, and in 1732 (88.6%) patients at 6 weeks. Best-corrected visual acuity (BCVA) ≥6/18 was achieved in 1868 (93.4%) patients at 6 weeks, with 46 (2.3%) having BCVA <6/60, 24 (1.2%) of whom had preexisting retinal pathology. At 6 weeks, 1876 (93.8%) eyes had with-the-rule and 134 (6.2%) against-the-rule astigmatism (mean 0.7±1.25 D). Iris prolapse was noted in 3 (0.15%), wound leak in 3 (0.15%), and transient corneal edema in 136 (6.8%) eyes. Average surgery time was 6 minutes. Conclusions. Temporal SICS with number 11 disposable surgical blade and nucleus delivery by phaco-sandwich method gave excellent outcome with minimal astigmatism and low complication rate at economic cost.

Corneal Transplantation: Penetrating Keratoplasty

2020 ◽  
pp. 151-162
Author(s):  
Richard S. Koplin ◽  
David C. Ritterband ◽  
Emily Schorr ◽  
John A. Seedor ◽  
Elaine Wu
Keyword(s):  
Penetrating Keratoplasty ◽  
Corneal Transplantation

scholarly journals Corneal Neovascularization and Lipid Keratopathy after Intacs SK in Keratoconus

2013 ◽  
Vol 2 (3) ◽  
pp. 133-138
Author(s):  
Ramez Barbara ◽  
David Zadok ◽  
Adel Barbara ◽  
Shay Gutfreund
Keyword(s):  
Visual Acuity ◽  
Penetrating Keratoplasty ◽  
Corneal Neovascularization ◽  
Young Female ◽  
Spherical Equivalent ◽  
Corrected Visual Acuity ◽  
Optical Zone ◽  
Positive Results ◽  
Oval Shape ◽  
Best Corrected Visual Acuity

ABSTRACT Intacs have yielded positive results for the treatment of keratoconus in terms of reducing the keratometry readings astigmatism and spherical equivalent and consequently improving the uncorrected and best corrected visual acuity. Intacs severe keratoconus (SK) are new design of Intacs with a smaller optical zone (6 mm) and oval shape, they are indicated for severe keratocnus. Pannus is one of the complications of Intacs, as it has never been reported after Intacs SK. We report on corneal neovascularization in the corneal periphery which developed few months after Intacs SK implantation in the cornea of a young female who suffered from advanced keratoconus. The uncorrected visual (UCVA) acuity was satisfactory and the Intacs SK where not removed. Four years after the implantation she presented to our clinic complaining about eye irritation and photophobia, lipid keratopathy was observed. We gave here the choice of explanting the Intacs SK or to try to treat the neovascularization by subconjunctival Avastin, she preferred the second option because of a satisfactory UCVA (0.9). Avastin was injected in the subconjunctival, 10 weeks later Avastin and Kenelog were injected in the subconjunctival, few days after the second injection perforation and melting developed in the cornea, the patient underwent a tectonic graft and few months later penetrating keratoplasty with no intraoperative or postoperative complications. How to cite this article Barbara A, Zadok D, Gutfreund S, Barbara R. Corneal Neovascularization and Lipid Keratopathy after Intacs SK in Keratoconus. J Kerat Ect Cor Dis 2013;2(3):133-138.

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